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Use of Ethical Principles to Combat Stigma in Psychiatric Nursing

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    Stigma greatly affects people with mental illness. A large portion of the population fears and socially rejects people with mental illness. Unfortunately, this includes nurses and mental health care professionals (Sobstyl, week 6). Also, stigma is a hindrance for the mentally ill that are in the preliminary stage of the illness to seek for help (Sobstyl, week 6). Often, they seek out professional help when their mental illness already reached a more serious stage. Having said that, psychiatric nurses play a fundamental role in helping patients with mental illness combat stigma.

    In order to achieve this, psychiatric nurses needs to be equipped with ethical theories like deontology, utilitarianism, virtue ethics, and ethics of care as this will ultimately serve as their grounds for truth (Yeo, 49). This essay will discuss why deontology is the best ethical approach in psychiatric nursing to combat stigma surrounding mental illness. In addition, this essay will point out visible contributions and weaknesses of the other mentioned ethical theories and show examples of their practical application. Deontology is a philosophical theory based on a universal moral duty.

    I found this theory as the best approach in psychiatric nursing to combat stigma in mental illness. The first and most important reason why I chose this theory is because deontology treats everyone equally and protects people’s rights (Sobstyl,week 3). Having mentioned that, deontological reasoning will always refer to the mentally ill as persons regardless of their physical or mental state. This is very important because people suffering from mental illness are vulnerable minorities which are to be protected, and treated equally. Deontology is often compared to the golden rule (Gibson, 2004).

    In other words before I can label a person with mental illness as a societal burden, I need to ask myself. What if I am the one with the mental illness, would I want people to label me as burden? The answer is no. This kind of deontological reasoning protects the rights of people with mental illness, and psychiatric nurses are advocate to patients’ rights (Gibson, 2006) The second reason why I think deontology is the best approach to combat stigma surrounding mental illness is its strictness. In essence, it strictly promotes human dignity (Sobstyl, week 3).

    It doesn’t allow for the public and the mental health care providers to take advantage of the weaknesses of people with mental illness. Deontology states that we treat the mentally ill as ends in themselves (Gibson, 2004) In other words, treat them as we would treat ourselves and not thinking about the advantages this would give us. The final reason-with no lesser value from the first two-is that deontology supports autonomy. Deontological approach states that every adult person has the right to decide for his own life and no one else (Yeo, 51).

    Autonomy is important for people with mental illness as it eliminates their own personal stigmas towards themselves. Autonomy gives a person liberty and self-determination (J. S Mill-Concepts, 143). One example would be a psychiatric nurse not bothering to ask a patient’s stand about a procedure that would normally require the patient’s authority. He or she may do this for personal benefits like making his/her job easier. Having mentioned of its strict moral laws, deontology would not condone this behavior.

    The second approach that I will choose in psychiatric nursing to combat stigma surrounding mental illness is virtue ethics. Since virtue ethics is based on acquiring good character traits and making them as habits (Sobstyl, Week 5, part1), it makes this theory the most genuine tool to care for others. Virtuous nurses have the greatest positive effects on the lives of patients with mental illness (Virtue thread, 01-31-13). People with mental illness tend to be warmer to nurses who have good character traits (Virtue thread,0 2-05-13).

    This type of relationship combats stigma because it makes patients feel more welcome in a community setting. In addition, the general population needs good role models and educators in order to combat stigma surrounding mental illness. The theory of virtue ethics prepares psychiatric nurses to be excellent role models and educators (Sobstyl, week 5, part 1). Also, a virtuous psychiatric nurse will be virtuous by character on or off duty (Virtue thread, 02-01-13). This means that they are great ambassadors to combat stigma outside of the clinical setting as well where most developing stages of mental illness are easily cured.

    However, virtue ethics cannot be considered the best approach to combat stigma because of one significant drawback. In some clinical situations, one or more virtues might conflict another virtue and can be non-beneficial for the patient (Virtue thread, 02-06-13). For example, if a psychiatric nurse puts too much inclination in being kind and pity, he/she might have a tendency to pamper the patient with psychiatric illness. Since virtue ethics is not a specific problem solving theory (Sobstyl, week 5, part1), it doesn’t look at rules nor consequences.

    This could result with the patient feeling dependent to the healthcare provider and not empowered. This goes against the idea of patient autonomy and instead of combating stigma; it puts more stigma in the person with mental illness. . The third theoretical approach I will discuss is ethics of care. This theory arises from a negotiated application of both the justice orientation and care orientation (Gibson, 2006). This means ethics of care have the flexibility to oversee the overall techniques for patient empowerment at the same time protects the patient’s rights.

    Both are essential to combat stigma. On the contrary, ethics of care have drawbacks we can compare to virtue ethics in a sense that its flexibility lacks stability (Yeo, 58). Ethics of care is an agent based approach and that given in a mental healthcare setting; this theory would greatly rely on the judgment of the health care provider (Care, 02-06-13). This ethical theory can bring no stability on the outcome for patients because every agent would weight justice or care orientations differently and arguably at times base them on personal assumptions (Care, 02-06-13).

    For example, given a current controversial issue in healthcare which is whether or not to use traditional scientific based therapies versus non-scientific based therapies (Gibson,2006), We cannot draw conclusions that the traditional scientific therapies will always be better that the non-scientific based. If the patient has religious upbringing, pastoral therapy may bring the patient to come into terms with his/her mental illness which is required to eliminate stigma. However, this is not true in all mental health care situation, the opposite effect can also possibly happen which may lead to promote the stigma.

    In ethics, care alone is not sufficient (Sobstyl, week 5, part 2). If we want to convey the public about the truth behind stigma surrounding mental illness, we need to follow strict rules so we can combat stigma outside of the mental health care setting. Given the flexibility of this theory, we might be tempted to justify personal reasons of people that promote the stigma itself. Unlike ethics of care, the theory of deontology follows a strict rule that states that it is imperative to treat people with mental illness as equal individuals, with dignity and respect regardless of personal reasons or feelings.

    The last ethical approach utilitarianism, gives emphasis on the consequences of an action and states that an action should bring the greatest good and satisfy the greatest number of subjects (Sobstyl, week 4). When applied, this approach is least likely to help combat the stigma surrounding mental illness. The reason being is that collective happiness may hide the individual value of a person or group, that although in a minority, deserves help (Gibson, 2004). For example, given a setting where an old man with schizophrenia is in a room with a married couple having another mental illness.

    A dilemma might rise where there’s only one bed. A psychiatric nurse following the utilitarian view would obviously give the bed to the couple since there are two of them and they can share the bed. This act is stigmatizing the old man with schizophrenia in a sense that he is labeled to have less value compared to the couple. Now, for all we know the old man can be a war veteran who saved thousands of people and is considered a war hero, or he can be just a regular man. In a utilitarian view, this is not important because he’s a minority in this case.

    Another interpretation of the utilitarian view would involve weighing satisfaction over suffering (Sobstyl, week 4). One implication that may arise in the mental health care setting is that when we are dealing with mentally ill patients, they may express their emotions differently (Utilitarianism,01-03-13). Using the utilitarianism approach in this case would be difficult because it is not possible to tell if the patient is truly satisfied or truly suffering. As a result, mental health care professionals will have a tendency to stigmatize patients without further scrutiny to their reasoning.

    Lastly, and probably the biggest drawback of utilitarianism in combating stigma around mental illness is that people with mental illness is a vulnerable minority group that are relying on the general public for help. If utilitarian views are to be followed. We would simply reject the welfare and interest of this minority as it will prove beneficial and convenient for the general population. People with mental illness faces social rejection called stigma. Everybody including mental health care workers can inflict stigma on this vulnerable population.

    As a result of being exposed to stigma, patients with mental illness to lose their will to live. Having said that, psychiatric nurses play a vital role in combating this stigma. In order to do that they need to be equipped with ethical theories that will ultimately guide them to promote the truth behind these stigmas. Having laid out these theories and discussing their contributions and weaknesses in combating stigma. I conclude that deontology is the best ethical approach in psychiatric nursing in a sense that it promotes equality, protects the rights and dignity and finally supports autonomy of people with mental illness.

    These reasons combined forms a solid ground to combat stigma. In addition, virtue ethics also provides another strong ground for combating stigma because it promotes genuine care in the mental health care setting and trains nurses to be good role models inside and outside of the mental health setting. On the contrary, ethics of care and utilitarianism have characteristics that aren’t stable for psychiatric nursing and can ultimately add to the stigma surrounding mental illness.

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